title: Reinnervation of bilateral posterior cricoarytenoid muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis.
abstract: OBJECTIVE
  To evaluate the feasibility, effectiveness, and safety of reinnervation of the bilateral posterior cricoarytenoid (PCA) muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis.
  
  
  METHODS
  Forty-four patients with bilateral vocal fold paralysis who underwent reinnervation of the bilateral PCA muscles using the left phrenic nerve were enrolled in this study. Videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time, pulmonary function testing, and laryngeal electromyography were performed preoperatively and postoperatively. Patients were followed-up for at least 1 year after surgery.
  
  
  RESULTS
  Videostroboscopy showed that within 1 year after reinnervation, abductive movement could be observed in the left vocal folds of 87% of patients and the right vocal folds of 72% of patients. Abductive excursion on the left side was significantly larger than that on the right side (P < 0.05); most of the vocal function parameters were improved postoperatively compared with the preoperative parameters, albeit without a significant difference (P > 0.05). No patients developed immediate dyspnea after surgery, and the pulmonary function parameters recovered to normal reference value levels within 1 year. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. Eighty-seven percent of patients in this series were decannulated and did not show obvious dyspnea after physical activity. Those who were decannulated after subsequent arytenoidectomy were not included in calculating the success rate of decannulation.
  
  
  CONCLUSIONS
  Reinnervation of the bilateral PCA muscles using the left phrenic nerve can restore inspiratory vocal fold abduction to a physiologically satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, People's Republic of China.
authors.forename: Meng
authors.initials: M
authors.lastname: Li
authors.forename: Shicai
authors.initials: S
authors.lastname: Chen
authors.forename: Hongliang
authors.initials: H
authors.lastname: Zheng
authors.forename: Donghui
authors.initials: D
authors.lastname: Chen
authors.forename: Minhui
authors.initials: M
authors.lastname: Zhu
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Fei
authors.initials: F
authors.lastname: Liu
authors.forename: Caiyun
authors.initials: C
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007821:Laryngeal Muscles / Q000294:innervation* / Q000601:surgery; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D009416:Nerve Regeneration; D010699:Phonation / Q000502:physiology; D010791:Phrenic Nerve / Q000601:surgery*; D020127:Recovery of Function; D014826:Vocal Cord Paralysis / Q000601:surgery*; D014827:Vocal Cords / Q000294:innervation / Q000601:surgery*